Nonsteroidal anti-inflammatory drugs (NSAIDs) have shown efficacy in patients with osteoarthritis (OA) pain but are also associated with a dose-dependent risk of gastrointestinal, cardiovascular, hematologic, hepatic, and renal adverse events (AEs). Topical NSAIDs were developed to provide analgesia similar to their oral counterparts with less systemic exposure and fewer serious AEs. Topical NSAIDs have long been available in Europe for the management of OA, and guidelines of the European League Against Rheumatism and the Osteoarthritis Research Society International specify that topical NSAIDs are preferred over oral NSAIDs for patients with knee or hand OA of mild-to-moderate severity, few affected joints, and/or a history of sensitivity to oral NSAIDs.


Massage: There's an upside to your discomfort: It's a legit excuse to get a weekly massage. One study found that people who did had less lower back pain and disability after 10 weeks, compared with the control group—and general relaxation rubdowns worked just as well as structural massage targeted at specific parts of the body. Osteopathic and chiropractic therapies—in which joints and muscles get stretched and repositioned—have been shown to work, too. In a study published in the Annals of Family Medicine
Not as popular as many other essential oils, arnica oil belongs in every medicine cabinet. Considered generally safe for topical use, arnica oil used on the skin helps ease inflammatory pain associated with insect bites, bruises and even arthritis flare-ups. (5, 6) To treat bruises, applying arnica oil twice daily (as long as the skin is not broken) helps reduce bruising inflammation even better than low-concentration vitamin K formulations. (3)
In summer 2018 I had my first personal experience with dramatic relief from Voltaren Gel (topical diclofenac). It’s not the first time I have found it useful, but it was the first time it was amazing. I’d been having some unexplained knee pain intermittently for several weeks when it kicked up a notch or two and became constant and even started waking me up at night. When I finally remembered to try Voltaren Gel — I’m not sure what took me so long — things were bad enough that it was going to be obvious if it worked. And it was! After many days of constant discomfort ranging from 3-6 on a 10-scale, it just ended: half an hour after applying the stuff, I simply didn’t have that problem anymore. Hallelujah! It’s been weeks since then with no relapse. Although the pain was not terrible, this is actually one of the clearest examples of pain relief from any treatment that I’ve ever enjoyed.

NSAIDs don’t just damage your gut lining. They affect your gut bacteria, too. A study of regular users found that different NSAIDs caused different changes in gut bacteria.[5] Ibuprofen and arthritis drug celecoxib (Celebrex), for example, increased pathogenic Enterobacteriaceae, a family of bacteria that includes E. coli, Salmonella, and a number of lesser-known bacteria that contribute to eye, skin, respiratory, and urinary tract infections.[6]

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